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ARTICLE |

Refining the Treatment of Alcohol Withdrawal FREE

Richard K. Fuller, MD; Enoch Gordis, MD
[+] Author Affiliations

Reprint requests to National Institute on Alcohol Abuse and Alcoholism, 6000 Executive Blvd, Rockville, MD 20892-7003 (Dr Fuller).


JAMA. 1994;272(7):557-558. doi:10.1001/jama.1994.03520070077042
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An important advance of the past quarter century has been the use of benzodiazepines to treat alcohol withdrawal. The life-threatening consequence of alcohol withdrawal, delirium tremens, which formerly was a common cause for hospital admission, at least to public hospitals, is an uncommon occurrence today. The landmark multihospital controlled trial conducted by Kaim et al1 comparing chlordiazepoxide with placebo and three other drugs established the therapeutic efficacy of benzodiazepines for alcohol withdrawal. This fact is sometimes lost sight of as newer pharmacologic agents are introduced and evaluated for treatment of alcohol withdrawal. Because there are different drugs available to treat alcohol withdrawal, physicians may be confused as to which one and which dosage regimen should be used as first-line therapy.

See also p 519.

For example, clonidine is effective for treatment of alcohol withdrawal symptoms2 but is not recommended as first-line therapy because it does not prevent seizures.

REFERENCES

Kaim SC, Klett CJ, Rothfeld B.  Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry . 1969;;125:1640-1646.
Manhem P, Nilsson LH, Moberg A, Wadstein J, Hokfelt B.  Alcohol withdrawal: effects of clonidine treatment on sympathetic activity, the renin-aldosterone system, and clinical symptoms. Alcohol Clin Exp Res . 1985;;9:238-243.
Kraus ML, Gottlieb LD, Horwitz RI, Anscher M.  Randomized clinical trial of atenolol in patients with alcohol withdrawal. N Engl J Med . 1985;;313:905-909.
Malcolm R, Ballenger JC, Sturgis ET, Anton R.  Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry . 1989;;146:617-621.
Hayashida M, Alterman AI, McClellan AT, et al.  Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild to moderate alcohol withdrawal syndrome. N Engl J Med . 1989;;320:358-365.
Saitz R, Mayo-Smith MF, Roberts MS, Redmond HA, Bernard DR, Calkins DR.  Individualized treatment for alcohol withdrawal: a radomized double-blind controlled trial. JAMA . 1994;;272:519-523.
Wartenberg AA, Nirenberg TD, Liepman MR, Silvia LY, Begin AM, Monti PM.  Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcohol Clin Exp Res . 1990;;14:71-75.
Sellers EM, Naranjo CA, Harrison M, Devenyi P, Roach C, Sykora K.  Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther . 1983;;34: 822-826.
Sullivan JT, Sykora K, Schneiderman J, Narango CA, Sellers EM.  Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Br J Addict . 1989;;84:1353-1357.
Whitfield CL, Thompson G, Lamb A, Spencer V, Pfeifer M, Browning-Ferrando M.  Detoxification of 1024 alcoholic patients without psychoactive drugs. JAMA . 1978;;239:1409-1410.
Ballenger JC, Post RM.  Kindling as a model for alcohol withdrawal symptoms. Br J Psychiatry . 1978;;133:1-14.
Linnoila M, Mefford I, Nutt D, Adinoff B.  NIH conference: alcohol withdrawal and noradrenergic function. Ann Intern Med . 1987;;107:875-889.
Gordis E, Fuller RK.  Alcoholism.  In: Bayless TM, ed. Current Therapy in Gastroenterology and Liver Disease . St Louis, Mo: Mosby-Year Book Inc; 1994;:191-197.

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Kaim SC, Klett CJ, Rothfeld B.  Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry . 1969;;125:1640-1646.
Manhem P, Nilsson LH, Moberg A, Wadstein J, Hokfelt B.  Alcohol withdrawal: effects of clonidine treatment on sympathetic activity, the renin-aldosterone system, and clinical symptoms. Alcohol Clin Exp Res . 1985;;9:238-243.
Kraus ML, Gottlieb LD, Horwitz RI, Anscher M.  Randomized clinical trial of atenolol in patients with alcohol withdrawal. N Engl J Med . 1985;;313:905-909.
Malcolm R, Ballenger JC, Sturgis ET, Anton R.  Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry . 1989;;146:617-621.
Hayashida M, Alterman AI, McClellan AT, et al.  Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild to moderate alcohol withdrawal syndrome. N Engl J Med . 1989;;320:358-365.
Saitz R, Mayo-Smith MF, Roberts MS, Redmond HA, Bernard DR, Calkins DR.  Individualized treatment for alcohol withdrawal: a radomized double-blind controlled trial. JAMA . 1994;;272:519-523.
Wartenberg AA, Nirenberg TD, Liepman MR, Silvia LY, Begin AM, Monti PM.  Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcohol Clin Exp Res . 1990;;14:71-75.
Sellers EM, Naranjo CA, Harrison M, Devenyi P, Roach C, Sykora K.  Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther . 1983;;34: 822-826.
Sullivan JT, Sykora K, Schneiderman J, Narango CA, Sellers EM.  Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Br J Addict . 1989;;84:1353-1357.
Whitfield CL, Thompson G, Lamb A, Spencer V, Pfeifer M, Browning-Ferrando M.  Detoxification of 1024 alcoholic patients without psychoactive drugs. JAMA . 1978;;239:1409-1410.
Ballenger JC, Post RM.  Kindling as a model for alcohol withdrawal symptoms. Br J Psychiatry . 1978;;133:1-14.
Linnoila M, Mefford I, Nutt D, Adinoff B.  NIH conference: alcohol withdrawal and noradrenergic function. Ann Intern Med . 1987;;107:875-889.
Gordis E, Fuller RK.  Alcoholism.  In: Bayless TM, ed. Current Therapy in Gastroenterology and Liver Disease . St Louis, Mo: Mosby-Year Book Inc; 1994;:191-197.
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